Two so-called magic bullets of the international health community's armoury — pre-school vitamin A supplementation, assumed to reduce child mortality by a quarter and intestinal deworming, assumed to improve child nutrition, growth, and cognitive development — have been shown to have no significant effect on child mortality. This was revealed in one of the largest trials ever: A five-year trial of Deworming and Enhanced Vitamin A supplementation (DEVTA) in one million pre-school children in Uttar Pradesh, a trial larger than all other vitamin A trials combined. Its primary aim was to assess how effective these interventions would be on mortality among children aged one to six years. The paper from the trial was published on Monday in the Lancet, more than six years after the study was completed. It was conducted by King George's Medical University in Lucknow, along with the University of Oxford. "The Vitamin A trial does not substantiate the earlier claim of 30% reduction in mortality. Even with full compliance, the mortality reduction was between 5 and 11%. If the mortality reduction is so small, it calls into question the cost-effectiveness of such interventions," explained Dr Shally Awasthi from the pediatrics department of the university. She is the lead author of the study. (Source: TOI, Mar 20, 2013)

Almost one-fourth of women with suspected postpartum depression had bipolar disorders, and a majority of them had comorbid anxiety disorders, a review of 1,400 cases showed. (Source: Medpage Today) Osteopathic manual therapy (OMT) was effective in alleviating chronic low back pain to a clinically significant degree, a randomized study showed. (Source: Medpage Today)

Tamiflu resistance may be rising

The pandemic H1N1 influenza A strain -- now circulating as seasonal flu -- appears to be developing resistance to oseltamivir (Tamiflu) in Australia, a researcher is reporting at the annual meeting of the Australasian Society for Infectious Diseases. (Source: Medpage Today)

FDA clears travel packs for low T

The FDA has approved AndroGel 1.62%, a topical testosterone formulation, in a pocket-sized pack to treat men with hypogonadism, according to manufacturer AbbVie. (Source: Medpage Today)

Peer coaching improves glucose control in diabetes

Clinic-based peer health coaching significantly improved type 2 diabetes control among low-income primary-care patients, a 6-month randomized study found. The findings were published in the March/April issue of the Annals of Family Medicine by David H. Thom, MD, PhD, from the University of California, San Francisco, and colleagues. (Source: Medscape)

No extra complications with single-incision gynecologic laparoscopy

Complications are similar after single-incision and conventional gynecologic laparoscopy -- but that's not enough to justify widespread adoption of the single-incision approach at this point, say the authors of a systematic review and meta-analysis. (Source: Medscape)

(Dr KK Aggarwal, Group Editor in Chief, IJCP Group of Publications and eMedinews)

Holasthak, the best time to remove hatred

You cannot hate a stranger. Negative thoughts are absence of positive thoughts and hatred is only withdrawl of love. The very fact you only ‘hate’ someone you loved once means that it is easy to bring the love back and remove the hatred.

Some women with hydrosalpinx may have constant or frequent pain in their lower belly or abdomen. A vaginal discharge can also be associated with this condition.

Tat Tvam Asi………and the Life Continues……

(Dr N K Bhatia, Medical Director, Mission Jan Jagriti Blood Bank)

Organ transplantation

Organ transplantation is the moving of an organ from one body to another or from a donor site on the patient’s own body, for the purpose of replacing the recipient’s damaged or absent organ. The emerging field of regenerative medicine is allowing scientists and engineers to create organs to be re–grown from the patient’s own cells (stem cells, or cells extracted from the failing organs). Organs and/or tissues that are transplanted within the same person’s body are called autografts. Transplants that are recently performed between two subjects of the same species are called allografts. Allografts can either be from a living or cadaveric source. Organs that can be transplanted are the heart, kidneys, eyes, liver, lungs, pancreas, intestine, and thymus. Tissues include bones, tendons (both referred to as musculoskeletal grafts), cornea, skin, heart valves and veins. Worldwide, the kidneys are the most commonly transplanted organs, followed closely by the liver and then the heart. The cornea and musculoskeletal grafts are the most commonly transplanted tissues; these outnumber organ transplants by more than 10-fold.

A 50-foot female humpback whale became entangled in a spider web of crab traps and lines. The whale was weighted down by hundreds of pounds of traps that caused her to struggle to stay afloat. She also had hundreds of yards of line rope wrapped around her tail, her torso and a line tugging in her mouth.

A fisherman spotted her just east of the Farallone Islands (outside the Golden Gate) and radioed an environmental group for help. Within a few hours, the rescue team arrived and determined that she was so bad off, the only way to save her was to dive in and untangle her – a very dangerous proposition. One slap of the tail could kill a rescuer.

They worked for hours with curved knives and eventually freed her. When she was free, the divers say she swam in what seemed like joyous circles. She then came back to each and every diver, one at a time, and nudged them, pushed them gently around – she thanked them. Some said it was the most incredibly beautiful experience of their lives.

The guy who cut the rope out of her mouth says her eye was following him the whole time, and he will never be the same.

May you, and all those you love, be so blessed and fortunate… to be surrounded by people who will help you get untangled from the things that are binding you.

Dr. A K Gupta, Author of "RABIES - the worst death", Joint Secretary, Association for Prevention and Control of Rabies in India (APCRI)

Is there any specific treatment for clinical rabies?

There is no specific treatment for clinical rabies. Key to survival after exposure to rabies virus is administration of post-exposure prophylaxis (PEP) as soon as possible. Death is virtually inevitable once clinical signs develop. Medical management is supportive and palliative.

Situation: A diabetic hypertensive was denied a beta–blocker because of the traditional teaching. Reaction: Oh my God! You should have used nebivolol. Lesson: Make Sure that diabetics are not denied beta–blockers when indicated. Nebivolol has no side effect on glucose metabolism unlike atenolol.

Quote of the Day (Dr GM Singh)

The greatest gift you can give another is the purity of your attention. Richard Moss

Legal Question of the Day

(Dr MC Gupta, Advocate & Medico-legal Consultant)

Q. I find that consumer courts continue to issue notice to the doctor concerned when a patient files a complaint of medical negligence even without having a prior report from a competent doctor or committee of doctors to the effect that there is a prima facie case of medical negligence, in terms of Justice Katju’s judgment in the Martin F. D'Souza case. Why is it so?

Ans. It is so because the judgment titled as Martin F. D'Souza v. Mohd. Ishfaq, Supreme Court, decided on February 17, 2009, was later put in cold storage after it was practically overturned on 8 March 2010 by the judgment in V. Kishan Rao versus Nikhil Super Speciality Hospital & Another. As per this judgment, Justice Katju delivered the judgment "per incuriam".

Para 51 of the judgment reads:

"51. When a judgment is rendered by ignoring the provisions of the governing statute and earlier larger Bench decision on the point such decisions are rendered ‘Per incuriam’. This concept of ‘Per incuriam’ has been explained in many decisions of this Court. Justice Sabyasachi Mukharji (as his Lordship then was) speaking for the majority in the case of A.R. Antulay vs. R.S. Nayak and another reported in (1988) 2 SCC 602 explained the concept in paragraph 42 at page 652 of the report in following words:-

“Per incuriam” are those decisions given in ignorance or forgetfulness of some inconsistent statutory provision or of some authority binding on the court concerned, so that in such cases some part of the decision or some step in the reasoning on which it is based, is found, on that account to be demonstrably wrong."

Yesterday’s Mind Teaser: Because of difficulties with hemodialysis, peritoneal dialysis is initiated to treat a female client’s uremia. Which finding signals a significant problem during this procedure?

Deciding to take a day off from his important job, a young hot-shot broker went back to visit some of his professors at his old school. Entering the school, he saw a dog attacking a small child. He quickly jumped on the dog and strangled it.

The next day, the local paper reported the story with the headline "Valiant Student Saves Boy from Fearsome Dog."

The broker called the editor of the paper and strongly suggested that a correction be issued pointing out that he was no longer a student, but a successful Wall Street broker.

The following day, the paper issued a correction, with a headline that read, "Pompous Stock Broker Kills School Mascot."

In most such cases, the bullet passes completely through the skull. As it enters the skull, it produces a clean cut hole in the outer table and a larger hole in the inner table. At the exit point, these conditions are reversed and the hole in the outer table is larger than the hole in the inner table. These facts are often of importance in determining the direction of fire in bullet injuries of the head. The track of a bullet through the brain tissues varies greatly, depending on the range and stability of the bullet. On the other hand, if it remains high velocity at the time of impact with the skull, there may be considerable damage from the cavitation effect within the skull.

Fissured fractures often radiate through the vault and base of the skull from the bullet entrance and exit holes.

In certain bullet injuries of the head, the bullet may fail to emerge from the skull and in these cases an area of bony comminuting is often found at the site of lodgment.

When a bullet strikes the head at a tangent, penetration of the skull may fail to occur, but the force of the bullet may be sufficient to fragment the inner table at the site of impact. Delayed pressure effects and cranial edema may be produced as a result of this.

Consumption of alcohol during holi can be dangerous. It makes one prone to accidents and people who drink may end up quarreling with each other unnecessarily, said Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal President Heart Care Foundation of India and National Vice President Elect IMA.

There is no evidence that people who do not drink should drink during Holi. For social drinking, one should restrict the intake to less than 80 grams per week or 80 ml per day.

Alcohol impairs the intellect, which in turn impairs the power to judge individuals and discriminate between the opposites. The impairment in judgment can also lead to errors while driving leading to fatal accidents.

Three to four drinks are sufficient to raise the blood pressure to dangerously high levels in susceptible individuals. In patients who are prone to heart attacks, this dangerous rise in blood pressure can precipitate heart attack, paralysis and brain hemorrhage. The incidence of paralytic attacks is found to be high within 24 hours of heavy drinking.

Binge drinking (more than 5 pegs in one hour or six pegs in a day) is also associated with irregular heartbeats and increased incidence of sudden death. Heart and high blood pressure patients are therefore specifically cautioned not to indulge into heavy drinking.

Drinking one peg of alcohol (one ounce) in one hour can still be considered as safe (social drinking) as this amount of alcohol can be totally metabolized by the liver during one hour.

Consuming six tablets of paracetamol with alcohol, which is a common practice to reduce the hangover particularly by women, can produce fatal liver damage. Taking aspirin to reduce the hangover can also produce fatal hemorrhage in the stomach and hence should be avoided. The festival of Holi is to share happiness with each other while forgetting all the differences.

Similarly, the practice of consuming bhang, which can cause impairment in judgment and brain functioning, should also be avoided, added Dr Neelam Mohan Director Hepatology at Medanta -The Medicity.

Those who cannot restrict their alcohol intake should only take red wine as it contains antioxidants, polyphenols that slow cell deterioration. They also prevent plaque buildup and inhibit platelet formation. Natural sources of polyphenols are grape seeds, grape skin, aloe vera, green tea, chocolate and cocoa. The types of polyphenols in cocoa are flavonoids and flavanols, and contain catechins, epicatechins, and procyandins.

About HCFI: The only National Not for profit NGO, on whose mega community health education events, Govt. of India has released two National commemorative stamps and one cancellation stamp, and who has conducted one to one training on” Hands only CPR” of 31170 people since 1stNovember 2012.

The CPR 10 Mantra is – “within 10 minutes of death, earlier the better; at least for the next 10minutes, longer the better; compress the centre of the chest of the dead person continuously and effectively with a speed of 10x10 i.e. 100 per minute.”